JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 88 March 1995 A brief journey into medical care and disease in Ancient Egypt Richard Sullivan BSc(Hons) MBBS J R Soc Med 1995;88:141-145 Keywords: @00 SUMMARY Ancient Egypt was one of the greatest civilizations to have arisen, becoming the cradle of scientific enquiry and social development over 3 millennia; undoubtedly its knowledge of medicine has been vastly underestimated. Few artefacts survive which describe the medical organization, but from the extent of the diseases afflicting that ancient populus there would have been much to study. Evidence from papyri, tomb bas reliefs and the writings of historians of antiquity tell of an intense interest in the sciences, humanities and medicine born of an educated society which had overcome the superstitions of its nomadic ancestors. MEDICAL CARE Table 1 Dynasties ofAncient Egypt and the equivalent time periods Evidence of medical organization in ancient Egypt is of two (after Manetho) the and the Of the former, kinds, literary archaeological. Dynasty Period Approx Date BC never have classic writers, notably Herodotust, who may l-ll Archaic 3168-2705 at visited the area except around the Greek trading centre II-VI Old Kingdom 2705-2250 Naukratis in 400 BC, relied heavily upon reports of previous VII-X 1st Intermediate 2250-2035 travellers such as Hecataeus of Miletus2. There are further XI-XIII Middle Kingdom 2035-1668 brief accounts of medical practice within the Old XIV-XVI 2nd Intermediate 1720-1 550 of Testament3, Hittite state records4 and state archives XVIII-XX New Kingdom 1550-1 070 Babylonia and Assyria5. The latter group contains by far the XXI-XXXI Late Period 1070-332 the most important and exact body of knowledge. Two of Ptolemaic Greek Period 332-30 the Ebers most important works so far discovered have been Emperors Roman Period 30 Bc-395 AD and Edwin Smith papyri. The first medical papyrus was discovered in 1862 and was dated to 1600 BC, but it is believed to be a copy of a and much older work originally written around 2500 BC and Edwin Smith Papyrus, it lacked the overall coherence the former attributed to the 'father of medicine' Imhotep6, vizier, meticulous organisation so characteristic of architect, physician and astronomer to the Pharaoh Djoser work; however, in its favour was its relative completeness (IlIrd Dyn; Table 1, see Appendix). The Edwin Smith and breadth of discussion. surgical papyrus79, as it became known, dealt with 48 Many other medical papyri have been discovered: mostly traumatic surgical cases and, arguably, contains what Kahun12, Berlin13, Brooklyn Museum14, Chester Beatty15, may be the first description of the circulation of the blood; a Carlesberg16 and RamesseumI7, and these, although claim which, if true, would predate the Greek Democritus's fragmentary, have provided great insight into ancient crude description of the circulation in his treatise On Egyptian medical knowledge, and a glimpse into the Nutritionl0 by over two millennia. development of their medical system. In 1873 George Ebers acquired a second remarkable The inception of organized medical care belonged papyrus, the Ebers papyrus11, originally from Thebes and without doubt to the ancient Egyptians at the time of dated to 1555 BC, containing 876 remedies and using 500 Djoser (IlIrd Dyn), whose vizier Imhotep is credited with substances, plus brief annotations on surgery. Unlike the the creation of Egyptian medical science, and who later became identified by the Greeks as the deity Asklepious 8. The Greek philosopher Alexandrius Clemens (AD 200)19 has suggested that medical knowledge may have existed at even Heatherwood Hospital, Ascot, Berkshire, UK earlier times, as among the 42 fabled Hermetic books of Correspondence to: Dr R Sullivan BSc(Hons) MBBS, Research Fellow, Department Egyptian medicine he credits Athothis (I Dyn), son of Menes 141 of Physiology, University College London, London WC1 E 6JJ, UK JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 88 March 1995 the first Pharaoh and uniter of Upper and Lower Egypt, with Figure 2 An the volume on anatomy (see Appendix). However, what is achondroplastic certain from archaeological evidence is that by the time of female dwarf Djoser and Imhotep there existed a well established system from the tomb of Tutankamen care. scripts a hierarchy of of medical Hieratic talk of (Wellcome medical care starting with the 'swnw' (ordinary doctor); 'imy- Institute Library, r swnw' (overseer of doctors); 'wr swnw' (chief of doctors); London, UK) 'smsw swnw' (eldest of doctors); and, finally, 'shd swnw' (inspector of doctors)20. It appears from texts that there was some distinction between physicians and surgeons, the latter as a group were often referred to as 'priests of the goddess Sekhmet'20 (pp 9-1 1). Further, it is interesting to note that women were also doctors, with a particular relief describing a certain Pereshet as 'imy-rt-swny', lady director of lady physicians20 (pp 1-2); this is, however, the only reference so far discovered to support the theory that women also held medical posts in what was essentially a male dominated society. Doctors were also very much specialized. A certain Sekhetnankh21 was described as the 'nose doctor' to Sahure (V Dyn; see Appendix) and a limestone bas relief of Iry (IV Dyn), a royal physician, shows him to be 'guardian of the royal bowel movement'22. Specific deities were also Nephthys (lungs); Neith (stomach); and Selke (intestines). associated with medical specialization: Duaw (eye Physicians aligned themselves with the respective gods or diseases); Taurt and Hathor (childbirth and its goddesses, according to theiir specialization. complications); Sekhmet (pestilence, probably infectious and Horus (snakebites, probably toxicology). diseases); DISEASE IN ANCIENT EGYPT Deities were also associated with specific organs: Isis (liver); Ancient Egyptians suffered from a variety of diseases, both Tuakau'and tobtawhicheeae umfidsl-bras a result of their Figure 1 congenital acquired, developed Alabaster dwarf cultural practices and environment. from XXth Although rare, achondroplasia has been depicted in many Dynasty bas reliefs and omrnaents. Two of the finest were (Wellcome examnples Institute Library, in the sarcophagus of Djehor (late period) on which was London, UK) depicted an achondroplasiac dancer, and from Tutankhamun's tomb23 an alabaster boat sailed by an achondroplasiac. Such was the fascination these individuals inspired that their unique forms were deffied as the Bes-god who became the divine protector of pregnant women from the New Kingdom onwards24 The results of consanguineous mamrages were often evident within the Pharaonic household. Autopsy of Amenophis IHI's (see Appendix) mummy demonstrated gynaecomastia and signs of feminization, including hypogonadism probably as a result of inbreeding, and although the father of six daughters he would almost certainly have suffered from a degree of infertility. Two of his granddaughters, Meretatim and Ankhsenpaatin, married close cousins, the former Smenkhkare and the latter the now familiar name of the future Pharaoh, Tutankhaten (see Appendix). Noteworthy is Howard Carter's excavation of 142 which suffered from Sprengel's disease25: a condition most JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 88 March 1995 Figure 3 were eviscerated and from which were isolated calcified Achondroplastic on the Bilharzia eggs3l. Further demonstration of Bilharzia infection srophagus of and its consequences were found at autopsy of the mummy Diehor, Late of Ramesses V (see Appendix) who, apart from skin damaged by smallpox, demonstrated gynaecomastia, (Welcome Institute Library, enlarged scrotal sac and an umbilical hernia; all London, UK) complications of long-term Bilharzia infection32. The ancient Egyptians suffered numerous epidemics and often tomb art described pestilence and death in years when the Nile's inundation failed. The use of genetic techniques such as polymerase chain reaction (PCR) has enabled medico-Egyptologists to determine the types of infection that afflicted this ancient population and so build a picture of disease migration and prevalence during almost the entire Dynastic period33'34. Further parasitic infestations have come to light; Hydatid disease in the lung cavity of the mummy of Asru and a space-occupying cranial lesion, thought to be a tapeworm cyst, in mummy 22940 of the Manchester Museum Mummy collection35. The mummy of the XX Dynasty weaver Nakht, in the reign of Smenkhkare (see Appendix), was shown to have been infested with Taenia, Trichenella spiralis and Bilharzia; a situation that must have been commonplace36'37. Other prevalent afflictions in ancient Egypt were likely a result of the genetic stagnation due to the arthritis, osteomyleitis and periostitis; of 133 mummies consanguineous practices of the Royal court. screened in 1961, 30% were shown to have Harris's lines38. Acquired conditions were numerous, and resulted in A further study of 185 Nubian skeletons dating from 1500- significant morbidity among the population, although 1000 BC, showed that women were by far the greatest ironically by the time of the Greek period travel to Egypt sufferers from disease, probably as a result of poorer to enjoy its dry sunny climate was hailed as a remedy for a nutrition and the demands of childbirth. Unlike most multitude of ailments26. Western societies, ischaemic heart disease and cancer were Leprosy (Mycobacterium leprae) is believed to have both rare as neither the diet nor the relative shortness of arisen in China in the first millennium BC, with the armies of their lives predisposed to such conditions. However, the Alexander the Great bringing the disease, via India, to Egypt mummy of Ramesses II (see Appendix) was reported to have around 350 BC27. In 1980, four skeletons dating from the lived 90 years (after Manetho) and had calcified temporal Greek period28, were discovered with leprosy. A far more arteries33 and that of Lady Teye (XXI Dyn), entombed at prolific condition afflicting the Nile valley inhabitants, also Deir el-Bahri, was shown to have atheroma of the coronary caused by a mycobacterium, was prevalent as early as 3300 arteries and mitral valves39.